|
INSURANCE
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />WESTCON-04 LGLEASON
<br />DATE (MMIDDIYYYY)
<br />12/24/2014
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s). ,
<br />PRODUCER
<br />Collinsworth, Alter, Lambert, LLC
<br />23 Eganfuskee Street
<br />Suite 102
<br />Jupiter, FL 33477
<br />CONTACT Lori
<br />NAME: B. Gleason
<br />CAH/c3,1•70, 561 776-9001 FAX (561)427-6730
<br />Ext): ( )INC, No):
<br />Mess Igleason/callIc.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC C
<br />INSURER A.Amerisure Insurance Co
<br />19488
<br />INSURED
<br />West Construction, Inc.
<br />X18 South Dixie Highway
<br />Suite 45
<br />Lake Worth, FL 33460
<br />INSURER B: North River Insurance Company
<br />21105
<br />INSURER C.
<br />01/01/2016
<br />INSURER D.
<br />5 1,000,000
<br />INSURER E:
<br />CLAIMS -MADE ( X [OCCUR
<br />INSURER F.
<br />s 100,000
<br />COVERAGES
<br />CERTIFICATE NUMBER:
<br />•
<br />T1-115 IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS' AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />(LTR
<br />TYPE OF INSURANCE IMSDibUjB
<br />POLICY NUMBER(MM/DD/YYYY)
<br />POLICY EFF
<br />POtIC
<br />POLICY EXP
<br />( YYYY)
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />:PP2085774013015
<br />01/01/2015
<br />01/01/2016
<br />EACH OCCURRENCE
<br />5 1,000,000
<br />CLAIMS -MADE ( X [OCCUR
<br />DAMAGES(c
<br />PREMISES (Ea Eaoccurrrcence)
<br />s 100,000
<br />X
<br />XCU & Contractual
<br />MED EXP (Any one person)
<br />S 5,000
<br />X
<br />Broad Form Prop. Dam
<br />PERSONAL 8 ADV INJURY
<br />s 1,000,000
<br />GEN'L
<br />AGGREGATE LIMY APPLIES PER:
<br />POLICY I X I PELT 11 LOC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />s 2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />5 2,000,000
<br />5
<br />A
<br />AUTOMOBILE
<br />X
<br />X
<br />LIABILITY
<br />ANY AUTO_
<br />ALL OWNED
<br />AUTOS
<br />HIRED AUTOS
<br />X
<br />—
<br />SCHEDULED
<br />AUTOS
<br />NON -OWNED
<br />AUTOS
<br />CA12999291701
<br />01/01/2015
<br />01/01/2016
<br />E E SINGLE UMIT
<br />(�Eazcid
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />S
<br />BODILY INJURY (Per accident)
<br />5
<br />(PerPa dent) GE
<br />S
<br />PIP Coverage
<br />s 10,000
<br />B
<br />X
<br />UMBRELLALIAB
<br />ExCEssLu6
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />6811024627
<br />01/01/2016
<br />01/01/2016
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />S 20,000,000
<br />DED I X I RETENT1ON $ 0
<br />s
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
<br />CFFICERQAEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />II yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />WC204157408
<br />01/01/2015
<br />01/01/2016
<br />PER f 21113H -
<br />X STATUTE 1 I ER
<br />E.L EACH ACCIDENT
<br />s 1,000,000
<br />EL DISEASE - EA EMPLOYEE
<br />5 1,000,000
<br />EL DISEASE - POLICY UMIT
<br />S 1,000,000
<br />A
<br />A
<br />Rented/Leased Equip.
<br />Inland Marine
<br />QT6609215L272TIL14
<br />QT6609215L272TIL14
<br />01/01/2015
<br />01/01/2015
<br />01/01/2016
<br />01/01/2016
<br />Limit 200,000
<br />Scheduled Equipment
<br />DESCRIPTION OF OPERATIONS! LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />The Certificate Holder Is named as additional Insured including products and completed operations for general liability per form C07048, automobile liability,
<br />and umbrella (lability when required by written contract. General Liability and Auto Liability are primary and non contributory when required by written
<br />contract. Waiver of subrogation applies to general liability per CG7049, automobile liability, umbrella liability, and workers' compensation when required by
<br />written Contract. Umbrella extends over general liability, auto liability and employer's liability. Should any of the above described policies be cancelled,
<br />notice will be delivered In accordance with the policy provisions.
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />FOR PROPOSAL PURPOSES
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />go,i 8.42140.1
<br />ACORD 25 (2014/01)
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SKEET AND TRAP FACILITY IMPROVEMENTS FOR THE INDIAN RIVER COUNTY PUBLIC SHOOTING RANGE
<br />BID NO. 2016008 / INDIAN RIVER COUNTY
<br />
|